Lymphoma
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Adult
non-Hodgkinfs lymphoma is a disease in which malignant (cancer)
cells form in the lymph system.
The lymph
system is part of the immune
system and is made up of the following:
- Lymph:
Colorless, watery fluid that travels through the lymph system and
carries white
blood cells called lymphocytes.
Lymphocytes protect the body against infections
and the growth of tumors.
- Lymph
vessels: A network of thin tubes that collect lymph from
different parts of the body and return it to the bloodstream.
- Lymph
nodes: Small, bean-shaped structures that filter substances in
lymph and help fight infection and disease. Lymph nodes are
located along the network of lymph vessels found throughout the
body. Clusters of lymph nodes are found in the underarm, pelvis,
neck, abdomen,
and groin.
- Spleen:
An organ
that produces lymphocytes, filters the blood,
stores blood cells, and destroys old blood cells. It is located on
the left side of the abdomen near the stomach.
- Thymus:
An organ in which lymphocytes grow and multiply. The thymus is in
the chest behind the breastbone.
- Tonsils:
Two small masses of lymph tissue
at the back of the throat. The tonsils produce lymphocytes.
- Bone
marrow: The soft, spongy tissue in the center of large bones.
Bone marrow produces white blood cells, red
blood cells, and platelets.
Because lymph tissue is found throughout the body,
adult non-Hodgkinfs
lymphoma can begin in almost any part of the body. Cancer
can spread to the liver
and many other organs and tissues.
Non-Hodgkinfs lymphoma can occur in both adults and
children. Treatment for children, however, is different than
treatment for adults.
There are many
different types of lymphoma.
Lymphomas
are divided into two general types: Hodgkinfs
lymphoma and non-Hodgkinfs lymphoma. This summary refers to the
treatment of adult non-Hodgkinfs lymphoma.
Age, gender,
and a weakened immune system can affect the risk of developing adult
non-Hodgkinfs lymphoma.
Risk
factors for adult non-Hodgkinfs lymphoma include the
following:
- Being older, male, or white.
- Having one of the following medical
conditions:
- An inherited immune disorder.
- An autoimmune
disease.
- HIV/AIDS.
- Human T-lymphotrophic virus type I or Epstein-Barr
virus.
- A history of Helicobacter
pylori infection.
- Taking immunosuppressant
drugs after an organ transplant.
- Being exposed to certain pesticides.
- A diet high in meats and fat.
- Past treatment for Hodgkinfs lymphoma or
with radiation.
Possible signs
of adult non-Hodgkinfs lymphoma include fever, sweating, fatigue,
and weight loss.
These and other symptoms
may be caused by adult non-Hodgkinfs lymphoma or by other
conditions. A doctor should be consulted if any of the following
problems occur:
- Painless swelling in the lymph nodes in the
neck, underarm, groin, or stomach.
- Fever (unexplained).
- Drenching night sweats.
- Constant tiredness.
- Weight loss (unexplained) in the past 6
months.
- Skin rash or itchy skin.
- Pain in the chest, abdomen, or bones
(unexplained).
Tests that
examine the body and lymph system are used to help detect (find) and
diagnose adult non-Hodgkinfs lymphoma.
The following tests and procedures may be used:
- Physical
exam and history: An exam of the body to check general signs
of health, including checking for signs of disease, such as lumps
or anything else that seems unusual. A history of the patientfs
health habits and past illnesses and treatments will also be
taken.
- Complete
blood count: A procedure in which a sample of blood is drawn
and checked for the following:
- The number of red blood cells, white blood
cells, and platelets.
- The amount of hemoglobin
(the protein
that carries oxygen) in the red blood cells.
- The portion of the sample made up of red
blood cells.
- Blood
chemistry studies: A procedure in which a blood sample is
checked to measure the amounts of certain substances released into
the blood by organs and tissues in the body. An unusual (higher or
lower than normal) amount of a substance can be a sign of disease
in the organ or tissue that produces it.
- Lymph node biopsy:
The removal of all or part of a lymph node. A pathologist
views the tissue under a microscope to look for cancer cells.
One of the following types of biopsies may be done:
- Excisional
biopsy: The removal of an entire lymph node.
- Incisional
biopsy: The removal of part of a lymph node.
- Core
biopsy: The removal of part of a lymph node using a wide
needle.
- Needle
biopsy: The removal of part of a lymph node using a thin
needle. This procedure is also called a fine-needle aspiration
biopsy.
- Bone
marrow biopsy: The removal of a small piece of bone and bone
marrow by inserting a needle into the hipbone or breastbone. A
pathologist views both the bone and bone marrow samples under a
microscope to look for signs of cancer.
Certain
factors affect prognosis (chance of recovery) and treatment
options.
The prognosis
(chance of recovery) and treatment options depend on the
following:
- The stage
of the cancer.
- The type of non-Hodgkin's lymphoma.
- The patientfs age and general health.
- Whether the lymphoma has just been diagnosed
or has recurred
(come back).
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After adult
non-Hodgkinfs lymphoma has been diagnosed, tests are done to find
out if cancer cells have spread within the lymph system or to other
parts of the body.
The process used to find out the type of cancer
and if cancer cells
have spread within the lymph
system or to other parts of the body is called staging.
The information gathered from the staging process determines the stage
of the disease. It is important to know the stage of the disease in
order to plan treatment. The following tests and procedures may be
used in the staging process:
- Chest
x-ray: An x-ray
of the organs
and bones inside the chest. An x-ray is a type of energy beam that
can go through the body and onto film, making a picture of areas
inside the body.
- CT
scan (CAT scan): A procedure that makes a series of detailed
pictures of areas inside the body, taken from different angles.
The pictures are made by a computer linked to an x-ray machine. A
dye may be injected
into a vein or swallowed to help the organs or tissues
show up more clearly. This procedure is also called computed
tomography, computerized tomography, or computerized axial
tomography.
- PET
scan (positron emission tomography scan): A procedure to find
malignant
tumor
cells in the body. A small amount of radionuclide glucose
(sugar) is injected into a vein. The PET scanner rotates around
the body and makes a picture of where glucose is being used in the
body. Malignant tumor cells show up brighter in the picture
because they are more active and take up more glucose than normal
cells.
- MRI
(magnetic resonance imaging): A procedure that uses a magnet,
radio waves, and a computer to make a series of detailed pictures
of areas inside the body. This procedure is also called nuclear
magnetic resonance imaging (NMRI).
- Gallium
scan: A procedure to detect areas of the body where cells,
such as cancer cells, are dividing rapidly. A very small amount of
radioactive
material, gallium, is injected into a vein and travels through the
bloodstream. The gallium collects in the bones or other tissues
(organs) and is detected by a scanner.
- Bone
marrow biopsy: The removal of a small piece of bone and bone
marrow by inserting a needle into the hipbone or breastbone. A
pathologist
views both the bone and bone marrow samples under a microscope to
look for signs of cancer.
- Lumbar
puncture: A procedure used to collect cerebrospinal
fluid from the spinal column. This is done by placing a needle
into the spinal column. This procedure is also called an LP or
spinal tap.
The following
stages are used for adult non-Hodgkinfs lymphoma:
Stage
I adult non-Hodgkinfs lymphoma is divided into stage I and stage
IE (gEh stands for extranodal and means that the cancer is found in
an organ or tissue other than the lymph
nodes).
- Stage I: Cancer is found in a single lymph
node area.
- Stage IE: Cancer is found in an organ or
tissue other than the lymph nodes.
Stage
II adult non-Hodgkinfs lymphoma is divided into stage II and
stage IIE (gEh stands for extranodal and means that the cancer is
found in an organ or tissue other than the lymph nodes).
- Stage II: Cancer is found in two or more
lymph node areas on the same side of the diaphragm
(the thin muscle below the lungs
that helps breathing and separates the chest from the abdomen).
- Stage IIE: Cancer is found in an organ or
tissue other than the lymph nodes and may have spread to one or
more lymph nodes on the same side of the diaphragm.
Stage
III adult non-Hodgkinfs lymphoma is divided into stage III,
stage IIIE (gEh stands for extranodal and means that the cancer is
found in an organ or tissue other than the lymph nodes), stage IIIS
(gSh stands for spleen
and means that the cancer is found in the spleen), and stage
IIIS+E.
- Stage III: Cancer is found in lymph node
areas on both sides of the diaphragm.
- Stage IIIE: Cancer is found in lymph node
areas on both sides of the diaphragm and in one area of a nearby
organ or tissue other than the lymph nodes.
- Stage IIIS: Cancer is found in lymph node
areas on both sides of the diaphragm and in the spleen.
- Stage IIIS+E: Cancer is found in lymph node
areas on both sides of the diaphragm, in one area of a nearby
organ or tissue, and in the spleen.
In stage
IV adult non-Hodgkinfs lymphoma, the cancer either:
- is found throughout at least one organ or
tissue other than the lymph nodes and may be in lymph nodes near
this organ or tissue; or
- has spread throughout one organ or tissue
other than the lymph nodes and has spread to lymph nodes far away
from that organ.
Adult
non-Hodgkinfs lymphomas are also described in terms of how fast they
grow and the location of affected lymph nodes.
- Indolent
lymphomas: These tend to grow and spread slowly and have few
symptoms.
They are also called low-grade
lymphomas.
- Aggressive
lymphomas: These grow and spread quickly and have severe
symptoms. Lymphoblastic lymphoma, diffuse small noncleaved cell
lymphoma and Burkitt
lymphoma are 3 types of aggressive adult non-Hodgkinfs
lymphoma. Aggressive lymphomas are seen more frequently in
patients who are HIV-positive
(AIDS-related
lymphoma). Aggressive lymphomas are also called intermediate-grade
and high-grade lymphomas.
- Contiguous lymphomas: Lymphomas in which the
lymph nodes containing cancer are next to each other.
- Noncontiguous lymphomas: Lymphomas in which
the lymph nodes containing cancer are not next to each other, but
are on the same side of the diaphragm.
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Recurrent
adult non-Hodgkinfs
lymphoma is cancer
that has recurred (come back) after it has been treated. The
lymphoma may come back in the lymph
system or in other parts of the body. Indolent
lymphoma may come back as aggressive
lymphoma. Aggressive lymphoma may come back as indolent
lymphoma.
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There are
different types of treatment for patients with non-Hodgkinfs
lymphoma.
Different types of treatment are available for
patients with non-Hodgkinfs
lymphoma. Some treatments are standard
(the currently used treatment), and some are being tested in clinical
trials. Before starting treatment, patients may want to think
about taking part in a clinical trial. A treatment clinical trial is
a research study meant to help improve current treatments or obtain
information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the
standard treatment, the new treatment may become the standard
treatment.
Clinical trials are taking place in many parts of
the country.
Choosing the most appropriate cancer treatment is a decision that
ideally involves the patient, family, and health care team.
Radiation
therapy is a cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells.
There are two types of radiation therapy. External
radiation therapy uses a machine outside the body to send
radiation toward the cancer. Internal
radiation therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters
that are placed directly into or near the cancer. The way the
radiation therapy is given depends on the type and stage
of the cancer being treated.
Chemotherapy
is a cancer treatment that uses drugs to stop the growth of cancer
cells, either by killing the cells or by stopping the cells from
dividing. When chemotherapy is taken by mouth or injected
into a vein or muscle, the drugs enter the bloodstream and can reach
cancer cells throughout the body (systemic
chemotherapy). When chemotherapy is placed directly into the
spinal column, an organ,
or a body cavity such as the abdomen,
the drugs mainly affect cancer cells in those areas (regional
chemotherapy). To treat certain types of adult non-Hodgkinfs
lymphoma that spread to the brain, CNS
prophylaxis (chemotherapy given to kill cancer cells in the
brain or spinal
cord) may be used. The way the chemotherapy is given depends on
the type and stage of the cancer being treated.
Watchful
waiting is closely monitoring a patientfs condition without
giving any treatment until symptoms
appear or change.
Other types
of treatment are being tested in clinical trials.
Biologic
therapy is a treatment that uses the patientfs immune
system to fight cancer. Substances made by the body or made in a
laboratory are used to boost, direct, or restore the bodyfs natural
defenses against cancer. This type of cancer treatment is also
called biotherapy or immunotherapy.
There are different types of biologic therapy used in
treating adult non-Hodgkinfs lymphoma, including the
following:
- Monoclonal
antibody therapy: A cancer treatment that uses antibodies
made in the laboratory, from a single type of immune system cell.
These antibodies can identify substances on cancer cells or normal
substances that may help cancer cells grow. The antibodies attach
to the substances and kill the cancer cells or block their growth.
Monoclonal antibodies are given by infusion.
They may be used alone or to deliver drugs, toxins,
or radioactive material directly to cancer cells.
- Vaccine
therapy: Vaccine therapy uses a substance or group of substances
meant to cause the immune system (the complex group of organs and
cells that defends the body against infection
or disease) to respond to a tumor
and kill it.
High-dose
chemotherapy with stem
cell transplantation is a method of giving high doses
of chemotherapy and replacing blood-forming
cells destroyed by the cancer treatment. Stem
cells (immature blood cells) are removed from the blood or bone
marrow of the patient or a donor and are frozen and stored.
After the chemotherapy is completed, the stored stem cells are
thawed and given back to the patient through an infusion. These
reinfused stem cells grow into (and restore) the bodyfs blood
cells.
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Treatment of indolent,
stage
I and contiguous
stage
II adult non-Hodgkinfs
lymphoma may include the following:
- Radiation
therapy directed at the area where cancer
is located.
- Radiation therapy directed at the area where
cancer is located and nearby lymph
nodes.
- Chemotherapy
with radiation therapy.
- Chemotherapy alone or watchful
waiting for patients who cannot have radiation therapy.
- Radiation therapy directed at part or all of
the lymph
system.
Treatment of aggressive,
stage I and contiguous stage II adult non-Hodgkinfs lymphoma is
usually combination
chemotherapy (chemotherapy using more than one drug) with
radiation therapy. Chemotherapy alone may also be used.
Treatment of indolent, noncontiguous
stage II/III/IV
adult non-Hodgkinfs lymphoma may include the following:
- Watchful waiting for patients who do not
have symptoms.
- Chemotherapy with or without steroids
(drugs used to relieve swelling and inflammation).
- Combination chemotherapy with steroids.
- Monoclonal
antibody therapy with or without combination chemotherapy.
- Radiolabeled
monoclonal antibody therapy.
- Radiation therapy directed at the area where
cancer is located and nearby lymph nodes, for patients who have
stage III disease.
- A clinical
trial of chemotherapy and total-body
irradiation (radiation therapy to the entire body) followed by
autologous
or allogeneic
stem cell transplantation.
- A clinical trial of chemotherapy with or
without vaccine
therapy.
Treatment of aggressive, noncontiguous stage
II/III/IV adult non-Hodgkinfs lymphoma may include the
following:
- Combination chemotherapy alone.
- Combination chemotherapy with radiation
therapy or monoclonal antibody therapy.
- Combination chemotherapy with CNS
prophylaxis.
- A clinical trial of autologous or allogeneic
stem cell transplantation for patients who are likely to relapse.
Treatment of adult lymphoblastic lymphoma may include
the following:
- Combination chemotherapy and CNS
prophylaxis.
- A clinical trial of autologous or allogeneic
stem cell transplantation.
Treatment of adult diffuse small noncleaved
cell/Burkitt lymphoma may include the following:
- Combination chemotherapy and CNS
prophylaxis.
- A clinical trial of combination
chemotherapy.
- A clinical trial of autologous or allogeneic
stem cell transplantation.
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Treatment of indolent,
recurrent
adult non-Hodgkinfs
lymphoma may include the following:
- Chemotherapy
with one or more drugs.
- Radiation
therapy.
- Radiation therapy and/or chemotherapy as palliative
therapy to relieve symptoms
and improve quality
of life.
- Monoclonal
antibody therapy.
- A clinical
trial of radiolabeled
monoclonal antibody therapy.
- A clinical trial of monoclonal antibody
therapy as palliative therapy to relieve symptoms and improve
quality of life.
- A clinical trial of autologous
or allogeneic
stem cell transplantation.
Treatment of indolent
lymphoma that comes back as aggressive
lymphoma may include the following:
- A clinical trial of autologous or allogeneic
stem cell transplantation.
- A clinical trial of combination
chemotherapy followed by radiation therapy or stem cell
transplantation and radiation therapy.
- A clinical trial of stem cell
transplantation.
- A clinical trial of monoclonal antibody
therapy.
- A clinical trial of radiolabeled monoclonal
antibody therapy.
- A clinical trial of continuous-infusion
chemotherapy (chemotherapy administered into a blood
vessel over a long period of time).
Treatment of aggressive, recurrent adult
non-Hodgkinfs lymphoma may include the following:
- Stem cell transplantation.
- Monoclonal antibody therapy.
- A clinical trial of autologous or allogeneic
stem cell transplantation.
- A clinical trial of combination chemotherapy
followed by radiation therapy or stem cell transplantation and
radiation therapy.
- A clinical trial of radiolabeled monoclonal
antibody therapy.
- A clinical trial of continuous-infusion
chemotherapy.
Treatment of aggressive lymphoma that comes back as
indolent lymphoma may include the following:
- Chemotherapy.
- Palliative therapy to relieve symptoms and
improve quality of life.
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